Ontario Disability Support Program Medical Review Training Course

Navigation • The following information will help you navigate the content of this elearning module. • Before we begin, let’s review how to use this e. Learning module. • Notice the navigation bar below the presentation. • Use the forward arrow to advance to the next slide or the backward arrow to return to the previous slide. • This module has audio narration, so make sure to turn on your speakers or plug in your headset! • If you are not able to complete the entire module in one sitting, use the Table of Contents section to the left of the screen to select the section from which you wish to continue when you are ready to resume.

Introduction • As a licensed health care professional, you may be asked to provide medical information for a patient who is undergoing a medical review for the Ontario Disability Support Program (ODSP). • The information you provide will help the Ministry of Community and Social Services (MCSS) assess whether your patient continues to be “a person with a disability, ” as defined by the ODSP Act, 1997.

Objectives By completing this e-learning module you will learn: • The ODSP medical review process. • Your role in the medical review process. • How to efficiently complete the form. • Key information the ministry needs. • How to receive payment for completing the forms.

Key messages • The Medical Form is designed to be streamlined and efficient, making it easier for health care professionals to complete. • The ministry needs this information to make a decision about whether your patient continues to qualify for ODSP. • To assist you to complete the form, your patient will be provided with the reasons they were originally found to be eligible for support. • If your patient’s medical condition, impairments and restrictions have not improved and will not improve, you will only need to complete Medical Form Part A.

Topics to Cover _______________ 1. 2. 3. 4. 5. 6. 7. Introduction to Medical Review Process Introduction to the Form Completing Part A Completing Part B Billing and Payment Information Testing your knowledge Short Survey

1 ______________ Introduction to Medical Review Process

What is ODSP • ODSP is a provincial social assistance program that provides income support, health care benefits and employment supports to eligible Ontario residents who have disabilities. • To qualify for ODSP income support, a person must be: § 18 years of age or older; § a resident of Ontario; § in financial need; and § a person with a disability as defined by the ODSP Act, (unless a member of a prescribed class). • Most individuals must go through a disability determination process to determine if they meet the program’s definition of a person with a disability.

Who is a person with a disability The program’s definition of a person with a disability is found in the ODSP Act. Meeting the definition means that: 1. A person must have a substantial mental or physical impairment that is continuous or recurrent, and is expected to last one year or more, and 2. The impairment directly results in a substantial restriction in the person’s ability to attend to their personal care, function in the community or function in the workplace, and 3. The impairment, its duration and restrictions have been verified by an approved health care professional.

What is a medical review • When your patient was found to be a person with a disability under the ODSP Act, a medical review date may have been assigned. • A medical review date is only assigned if there is a likelihood of improvement in your patient’s impairments based on the information presented in their application. • A medical review is not a re-application – it focuses on changes to your patient’s original qualifying impairments and restrictions, and if necessary any new medical issues that have emerged since the previous ODSP disability decision.

Medical Review Process • MCSS has a centralized unit, the Disability Adjudication Unit (DAU), which is responsible for administering the medical review process. • Once you complete the medical forms, the completed Medical Review Package is submitted to DAU. • The DAU employs Disability Determination Adjudicators (adjudicators) who are specially trained to: § Assess all information to determine whether your patient continues to meet the definition of a person with a disability under the ODSP Act. § Set another medical review date unless there is no likelihood of improvement in the patient’s impairments. • The DAU will send a letter to your patient to tell them about the decision. You will receive payment by billing the Ontario Health Insurance Plan (OHIP) or submitting an invoice to the ministry.

2 ______________ Introduction to the Form

Medical Forms: Part A and Part B Part A • Collects current information about the medical conditions, Part B • Identifies medical conditions impairments and restrictions that are not listed in Part A. It is were identified in the previous only completed if necessary, ODSP disability decision. Part A based on the answers to the must be completed. questions asked at the end of Part A.

Summary of the Disability Decision • This summary provides the reasons your patient was originally found to be a person with a disability and may assist you in completing the Medical Forms.

Overview on completing forms

3 ______________ Completing Part A

Who may complete Part A Medical Form Part A may be completed by an Ontario registered: • Nurse Practitioner. • Optometrist. • Physician. • Psychologist. • Psychological Associate. • Registered Nurse.

Part A Section 1 Previously identified medical conditions, impairments and restrictions: • The form is pre-populated with information from the time your patient was found to be a person with a disability. • You will need to describe any clinically significant change in listed impairments and restrictions or indicate if there has been no change since the date of the decision. • Each page also contains your patient’s personal information.

Part A Section 1. 1: Prognosis, impairments and duration

Part A Section 1. 1: Restrictions

Part A Section 1. 2: Questions • To determine if you need to provide further information in Section 2, you will need to answer two questions in Section 1. 2: Question 1: Did any impairments or restrictions listed in Section 1 show clinically significant improvement? Yes or No. Question 2: Did you indicate for any medical condition in Section 1 the prognosis is to “improve” or is “unknown”? Yes or No.

Part A Section 1. 2: Answers • If there is no improvement and improvement is not expected: Answer 1: No. Answer 2: No. • If you have answered No to both questions, do not complete Section 2 and proceed directly to Section 3 to sign and date the form. • Do not complete Part B. No further information is needed.

Part A Section 3 • Sign and date the form.

Going Back to Section 1. 2: Questions Question 1: Did any impairments or restrictions listed in Section 1 show clinically significant improvement? Yes or No. Question 2: Did you indicate for any medical condition in Section 1 the prognosis is to “improve” or is “unknown”? Yes or No.

Going Back to Section 1. 2: Answers • If there is an improvement or improvement is expected or unknown, there are 3 ways to answer the questions: § § § • Yes and No No and Yes If you have answered Yes to either question, complete Section 2. The ministry needs this information to make a decision about whether your patient continues to qualify for ODSP.

Part A Section 2. 1: Medical and other available information 2. 1. You have a choice to either describe or attach available information on: A. Examination Findings. B. Other Findings. C. Treatments or Interventions. D. Impact of impairments and restrictions on patient’s day-to day activities. E. Prognoses. F. Other information that might be useful in understanding the patient’s current situation.

Part A Section 2. 2 Answer the question in Section 2. 2 to determine if Part B needs to be complete. Question • Are there any other medical conditions not listed in Section 1 that: § present with impairments and restrictions, and § contribute to the patient’s current status. Yes or No. Answer • If you answered No, do not complete Part B. Proceed to Section 3 to sign and date the form. Nothing further is required. • If you answered Yes, complete Part B. Before you go to Part B, complete Section 3 of Part A.

4 ______________ Completing Part B

Who may complete Part B Medical Form Part B has two sections, the Health Status Report (HSR) and the Activities of Daily Living (ADL). The HSR and ADL may be completed by an Ontario registered: • • • Nurse Practitioner. Optometrist. Physician. Psychologist. Psychological Associate. Registered Nurse. The ADL only may be completed by an Ontario registered: • • • Audiologist. Chiropractor. Occupational Therapist. Physiotherapist. Social Worker. Speech Language Pathologist.

Part B Section 1 • Medical conditions not listed in Part A that contribute to the patients current status

Part B Section 2 2. 1 Are any of the medical conditions you reported in Section 1 of Part B listed below? Mental health condition Yes or No. Substance-related or addictive disorder Yes or No. Neurodevelopmental disorder Yes or No. Other medical condition presenting with a mental impairment Yes or No. • If you answered No to all, please go to Section 3. • If you answered Yes to any, please complete Section 2. 2 and 2. 3.

Part B Section 2. 2 Describe available information including the history that might be useful in understanding the patient’s mental impairments or attach copies of available reports: A. Mental health condition. B. Substance-related or addictive disorder. C. Neurodevelopmental disorder. D. Other medical condition presenting with a mental impairment.

Part B Section 2. 3: Intellectual and Emotional Wellness Scale • 28 -item scale. • Ratings address both the severity and frequency of each symptom. • Open area for comments on fluctuations in severity for episodic symptoms.

Part B Section 3: Medical and other available information Please note: In Section 3 you do not have to repeat the information already provided in previous sections. 3. 1 Please describe available information, if applicable. A. Examination Findings. B. For recurrent or episodic impairments, describe how fluctuations in severity affect the patient. 3. 2 Have any consultations or assessments been completed by another health care professional? Yes or No. • If No, please comment (example: pending, waiting list, not available). • If Yes, please select the type and describe relevant findings or attach copies of the available report.

Part B Section 4: Visual • Complete this section if your patient has a visual condition or impairment (vision loss). Please attach the most recent available visual assessment (example visual acuity / visual field test).

Part B Section 5: Auditory • Complete this section if your patient has an auditory condition or impairment (example hearing loss). Please attach the most recent available auditory assessment (example audiogram).

Part B Section 6: Interventions and Treatments 6. 1 Is the patient receiving any interventions and treatments for conditions and impairments listed in Part B? Yes or No. A. If No, please comment. Example: pending, side effects, no definitive diagnosis, treatment not available. B. If Yes, please complete appropriate fields and comment on progress. 6. 2 Describe any relevant past treatment and reason for discontinuation. 6. 3 Please provide any other information that might be useful in understanding the patient’s current situation.

Part B Sections 7 and 9: Certificate of Approved Health Care Professional • Sections 7 and 9 collect same information. • If you are continuing to Section 8 and completing the Activities of Daily Living you can complete Section 9 only. • If you are not completing the Activities of Daily Living section, please complete Section 7.

Part B Section 8: Activities of Daily Living 8. 1 Activities of Daily Living Index • 25 -item index made up of activities performed on a daily basis. • Rating scale ranges from 0 (no limitation) to 3 (severe limitation). • Open area for describing the limitations. 8. 2 Does the patient require any of the services or help listed below? If Yes, please describe. A. Assistive device or equipment B. Support service or resource C. Service or guide animal 8. 3 Please provide any additional comments about activities of daily living.

5 ______________ Billing and Payment Information

Billing and Payment Information You will receive payment by billing Ontario Health Insurance Plan (OHIP) or submitting an invoice to the ministry. To submit an invoice you will need to: • Create an invoice that includes 1. Your full name and profession, address and phone number 2. Your patient’s full name, date of birth, and member ID 3. The name of the form you completed (example Part A) • Mail your invoice to: Ontario Disability Support Program Disability Adjudication Unit Box B 18 Toronto, ON M 7 A 1 R 3

Fees The following fees are paid to approved health care professionals upon completion of Part A and Part B: • Medical Form Part A: $35. 00 (Code K 057) • Medical Form Part B: $125. 00 (Code K 058) (BOTH Health Status Report and Activities of Daily Living) • Medical Form Part B: $100. 00 (Code K 059) (ONLY Health Status Report) • Medical Form Part B: $25. 00 (Code K 060) (ONLY Activities of Daily Living)

Contact Information If you have any questions, you can contact the Disability Adjudication Unit: • By phone: § 416 -326 -5079 within Toronto 416 -326 -3372 TTY device in Toronto § 1 -888 -256 -6758 outside of Toronto 1 -866 -780 -6050 TTY device outside of Toronto • By fax: 416 -326 -3374

6 ______________ Test your knowledge

Remember • Medical Form Part A asks you to provide information about changes to medical conditions, impairments and restrictions that previously qualified your patient for the ODSP. • If your patient’s impairments and restrictions have not improved and the medical conditions will not improve, you will only need to complete Section 1 and Section 3 of Part A. • Only in cases where there is an improvement or improvement is expected or unknown, will you need to provide further information in Section 2 of Part A. You may also need to provide information about any new medical conditions in Part B.

Test your knowledge: Case 1 Based on the available medical and other evidence in your patient's chart, you conclude that: • Impairments and restrictions listed in Section 1 of Part A associated with Coronary Artery Disease do not show clinically significant improvement. • Prognosis for Coronary Artery Disease is to deteriorate. • Your patient is also diagnosed with Major Depressive Disorder not listed in Part A. Major Depressive Disorder presents with impairments and restrictions that contribute to your patient's current status. Which parts/sections will you complete? (Please select all that apply. ) A. Part A - Section 1 B. Part A - Section 2 C. Part A - Section 3 D. Part B

Case 1 Answer • Correct answer is A. and C. You will complete Part A Section 1 and Part A Section C.

Test your knowledge: Case 2 Based on the available medical and other evidence in your patient's chart, you conclude that: • Impairments and restrictions listed in Section 1 of Part A associated with Coronary Artery Disease show clinically significant improvement. • Prognosis for Coronary Artery Disease is unknown. • Your patient is also diagnosed with Major Depressive Disorder not listed in Part A. Major Depressive Disorder presents with impairments and restrictions that contribute to your patient's current status. Which parts/sections will you complete? (Please select all that apply. ) A. Part A - Section 1 B. Part A - Section 2 C. Part A - Section 3 D. Part B